Using Teaspoons for Giving Medicine to Kids Often Results in Dosing Errors

Many parents find dosing instructions that use teaspoons as a measure confusing and reach for a kitchen teaspoon, which delivers an imprecise dose. Image:©

Many parents find dosing instructions that use teaspoons as a measure confusing and reach for a kitchen teaspoon, which delivers an imprecise dose. Image:©

Doling out a dose of liquid medication for a child can be confusing and stressful for parents. They may fumble to find the right dosing device, struggle to understand the dosing directions, and have difficulty getting their child to take the medication. Under these circumstances, dosing errors are common and result in more than 10 000 calls to poison control centers and 3000 to 4000 emergency department visits each year.

But physicians can make the process easier and more error free by simplifying dosing directions, according to a study published today in the journal Pediatrics.

Many organizations, including the US Centers for Disease Control and Prevention, the Institute for Safe Medication Practices, and organizations representing retail pharmacies, have suggested switching to metric-only dosing for liquid medications to reduce dosing errors. But there has been some concern that US parents might be confused by milliliter doses. To assess the risks and benefits of milliliter vs teaspoon dosing, a team of researchers compared dosing error rates among 287 parents whose children were prescribed a liquid medication in either teaspoons or milliliters after visiting 1 of 2 emergency departments.

The researchers found that mistakes are common, regardless of the unit of measure. More than one-third of the parents made an error in measuring their child’s dose and an 41% didn’t understand the prescribed dose.

Many (16.7%) reached for implements such as kitchen spoons, which are vary in size and may lead to an incorrect dose. Parents who were given a prescription in teaspoons were more likely to make a measurement error than parents given a metric measurement(42.5% vs 27.6%). Many, but not all, of these errors occurred because parents given a prescription in teaspoons used a kitchen spoon or other nonstandard device. Parents with low health literacy and non-English speakers were particularly prone to errors when teaspoons were used as a measure.

Some of the confusion likely stems from different units of measurements on the bottle label, in the prescription, or in verbal instructions from health care professionals or pharmacists, according to the authors. This suggests that clinicians and pharmacies are exacerbating parents’ confusion by using different units of measure.

The authors conclude that the findings support the safety of switching to milliliters-only dosing, especially for parents who have low health literacy or who do not speak English.

“Our findings provide evidence in support of a growing national initiative to move to a milliliter-only standard and may allay fears about the elimination of teaspoon and tablespoon terms,” the authors wrote.

Categories: Emergency Medicine, Medication Error, Pediatric Dosing, Pediatrics

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